Healthcare Provider Details

I. General information

NPI: 1023262565
Provider Name (Legal Business Name): MINDA JANE STILLINGS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE
ALBUQUERQUE NM
87102-2360
US

IV. Provider business mailing address

1420 BRYN MAWR DR NE
ALBUQUERQUE NM
87106-1104
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-0701
  • Fax:
Mailing address:
  • Phone: 505-232-9125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2329
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: